Community-based rehabilitation intervention for people with schizophrenia in Ethiopia (RISE) cluster-randomised controlled trial: An exploratory analysis of impact on food insecurity, underweight, alcohol use disorder and depressive symptoms

Asher, Laura; Birhane, Rahel; Weiss, Helen; Medhin, Girmay; Selamu, Medhin; Patel, Vikram; de Silva, Mary; Hanlon, Charlotte; Fekadu, Abebaw

Abstract

We evaluated the effectiveness of community-based rehabilitation (CBR) in reducing depressive symptoms, alcohol use disorder, food insecurity and underweight in people with schizophrenia. This cluster-randomised controlled trial was conducted in a rural district of Ethiopia. Fifty-four sub-districts were allocated in a 1:1 ratio to the facility-based care [FBC] plus CBR arm and the FBC alone arm. Lay workers delivered CBR over 12 months. We assessed food insecurity (self-reported hunger), underweight (BMI< 18.5 kg/m2), depressive symptoms (PHQ-9) and alcohol use disorder (AUDIT ≥ 8) at 6 and 12 months. Seventy-nine participants with schizophrenia in 24 sub-districts were assigned to CBR plus FBC and 87 participants in 24 sub-districts were assigned to FBC only. There was no evidence of an intervention effect on food insecurity (aOR 0.52, 95% CI 0.16–1.67; p = 0.27), underweight (aOR 0.44, 95% CI 0.17–1.12; p = 0.08), alcohol use disorder (aOR 0.82, 95% CI 0.24–2.74; p = 0.74) or depressive symptoms (adjusted mean difference − 0.06, 95% CI −1.35, 1.22; p = 0.92). Psychosocial interventions in low-resource settings should support access to treatment amongst people with schizophrenia, and further research should explore how impacts on economic, physical and mental health outcomes can be achieved.

• Journal Article Type: Article
• Acceptance Date: Oct 18, 2023
• Online Publication Date: Oct 25, 2023
• Publication Date: 2023
• Deposit Date: Nov 7, 2023
• Publicly Available Date: Nov 7, 2023
• Print ISSN: 2054-4251
• Electronic ISSN: 2054-4251
• Publisher: Cambridge University Press
• Peer Reviewed: Peer Reviewed
• Volume: 10
• Article Number: E70
• DOI: https://doi.org/10.1017/gmh.2023.67
• Public URL: https://nottingham-repository.worktribe.com/output/27075300
• Publisher URL: https://www.cambridge.org/core/journals/global-mental-health/article/communitybased-rehabilitation-intervention-for-people-with-schizophrenia-in-ethiopia-rise-clusterrandomized-controlled-trial-an-exploratory-analysis-of-impact-on-food-insecurity-underwei